血液超滤在利尿剂抵抗的失代偿性心力衰竭患者中的疗效及安全性分析

The efficacy and safety of ultrafiltration in patients with decompensated heart failure and diuretic resistance

目的评估血液超滤在利尿剂抵抗的失代偿性心力衰竭患者中的疗效及完全性。方法连续收集2017年3月至2019年3月武汉亚洲心脏病医院接受大剂量利尿剂后(80mg/d以上呋塞米,使用至少48h)仍存在明显液体潴留患者102例,分为超滤组50例和继续利尿剂组52例。结果治疗48h后,相比利尿剂组,超滤组液体出量更多(4826ml比1358ml,P=0.0002),体重下降更为明显(4.8kg比1.3kg,P=0.024),两组患者治疗前N末端B型脑钠肽前体(NT-pro BNP)水平比较差异无统计学意义[(25892.85±2563.25)pg/ml比(24592.34±2859.68)pg/ml,P=0.052],治疗后48h,NT-pro BNP水平超滤组下降程度更加明显[(-12580.62±1256.38)pg/ml比(-8567.75±1128.95)pg/ml,P=0.016]。超滤组住院时间明显降低(4.52d比7.58d,P=0.028)。两组患者30d内因心力衰竭急诊就医及再次住院次数差异无统计学意义(均P>0.05);90d内,超滤组患者急诊就医次数更少[(1.82±1.25)次比(3.28±1.83)次,P=0.048],再次住院次数更少[(1.56±1.24)次比(2.87±1.89)次,P=0.046]。标准EQ-5D-3L健康调查问卷评分,超滤组患者在出院和30d时评分降低更多[分别为(2.82±1.89)分比(1.92±1.24)分、(2.63±1.95)分比(1.23±0.86)分,P=0.032、0.028]。超滤组患者在治疗期间未发现不良事件。结论血液超滤在利尿剂抵抗的失代偿性心力衰竭患者中疗效肯定及安全可靠。

Objective To evaluate the efficacy and safety of ultrafiltration in patients with decompensated heart failure and diuretic resistanc.Methods 102 inpatients with serious fluids retention after treated with high-dosage of diuretic agents(80 mg Lasix daily for 48 hours)were enrolled and divided into ultrafiltration group(n=50)and diuretic group(n=52)between March 2017 and March 2019.Results After 48 hours treatment,the total fluid output and body weight decrease were significantly greater in ultrafiltration group than diuretic group(4826 ml vs.1358 ml,P=0.0002,4.8 kg vs.1.3 kg,P=0.024,respectively).NT-pro BNP concentration was similar between the two groups before and decreased significantly in ultrafiltration group than diuretic group[(-12580.62±1256.38)pg/ml vs.(-8567.75±1128.95)pg/ml,P=0.016]after treatment.The ultrafiltration group had a shorter duration of hospitalisation(4.5 days vs.7.5 days,P=0.028).The incidences of emergency department visit and rehospitalisation for heart failure were not significant difference between the two groups in 30 days(all P>0.05)and significantly lower in ultrafiltration group than in diuretic group in 90 days[(1.82±1.25)vs.(3.28±1.83),P=0.048,(1.56±1.24)vs.(2.87±1.89),P=0.046,respectively].The decrease of EQ-5 D score was more significant in ultrafiltration group than in diuretic group both at discharge[(2.82±1.89)vs.(1.92±1.24),P=0.032]and 30 days[(2.63±1.95)vs.(1.23±0.86),P=0.028]There was no adverse event during ultrafiltration.Conclusion Ultrafiltration is an effective and safety therapy for patients with decompensated heart failure and diuretic resistance.